Egalitarian Provision of Necessary Medical Treatment

Abstract

This article offers a new argument for egalitarian provision of genuinely necessary medical treatment. Under economic circumstances in which a government cannot guarantee necessary medical treatment to all citizens, it should prevent citizens' finances from affecting their access to treatments they genuinely need. To do this, government must place restrictions both on the private insurance market (as some Canadian provinces do now) and on out-of-pocket payments for medical services. Government must do this even if doing so would involve leveling down and even if it is unclear whether this policy would lead to better health care to the poor than would a tiered system that allowed people's finances to affect their access to necessary treatment. The grounds for egalitarianism about access to necessary medical treatment include considerations of autonomy and independence. If people's finances affect their access to necessary medical care, they will be subject to objectionable forms of private domination. My argument will build on premises that many liberal non-consequentialists will find attractive. I will not attempt to persuade utilitarians or right-wing libertarians. 5 My aim is to show that some moral premises that have been used to defend basic public support of the poor, including provision of "basic" health care, have more demanding implications. 6 The core of the 5 Left-libertarians may accept the argument, as may consequentialists who believe that individual autonomy or independence has non-instrumental value. 6 The premises I use are close to the premises of Kant's argument for public support of the poor, as recently interpreted by Gilabert (2010), Ripstein (2009, 25-26 and 267-286), andWeinrib (2003).Ripstein and Gilabert both note that Kant's argument supports a requirement to provide health care to all, but they do not claim that it requires equality in access to necessary treatment. My premises are in an important respect weaker than Kant's: I do not assume-as Kant does, on Ripstein's reading-that the only permissible end of government action is to protect citizens' independence, i.e., to prevent some citizens' continued effective exercise of rational agency from depending on others' discretionary good will. I defend the weaker claim that law must not itself empower some citizens to decide, entirely at their discretion, whether other citizens shall be sick or healthy. 4argument is an observation about the relationship between the opportunity to purchase access to health care and the possibility of dependence on charity. If private money can be used to buy access to medical treatment, some citizens' ability to get treatments they genuinely need without lawbreaking (without, e.g., stealing money or medicine) will depend on other citizens' legally discretionary choices to give or to withhold charity. Health law and property law will thus interact in a way that gives some private citizens discretionary power over other citizens' health. This power, I argue, is objectionable. It is objectionable for the s...

Tackling Inequalities in Oral Health: Bone Augmentation in Dental Surgery through the 3D Printing of Poly(ε-caprolactone) Combined with 20% Tricalcium Phosphate

“…However, ensuring equal access to healthcare through the development of less expensive treatments and targeted solutions cannot be dissociated from minimising the impact on the planet. Indeed, achieving an ethical and ecological global healthcare system is an important challenge for the future [ 49 ].…”